Agency for Toxic Substances and Disease Registry
Case Studies in Environmental Medicine (CSEM) 

Pediatric Environmental Health
Appendix E: Lead Screening

The 1997 revised Centers for Disease Control and Prevention (CDC) guidelines are based on blood lead and housing age data (CDC 1997).

Universal screening is still the policy for communities with inadequate data on the prevalence of elevated blood lead level (BLL) and in communities with ≥27% of the housing built before 1950.

Targeted screening is recommended in communities where <12% of children have BLLs ≥10 micrograms per deciliter (µg/dL) or where ≥27% of houses were built before 1950. This recommendation is based on an analysis suggesting that the benefits of universal screening outweigh the cost only when the prevalence of elevated BLLs is in the range of 11% to 14% or higher.

Other candidates to be considered for target screening include children

• 1 to 2 years of age living in housing built before 1950 in an area not designated for universal screening (especially if the housing is not well maintained)
• of ethnic or racial minority groups who might be exposed to lead-containing folk remedies
• who have emigrated (or been adopted) from countries where lead poisoning is prevalent
• with iron deficiency
• exposed to contaminated dust or soil
• with developmental delay whose oral behaviors place them at significant risk for lead exposure
• who are victims of abuse or neglect
• whose parents are exposed to lead (vocationally, avocationally, or during home renovation)
• of low-income families who receive government assistance (Supplemental Feeding Program for Women, Infants, and children; Supplemental Security Income; welfare; Medicaid [note that blood lead screening for children on Medicaid is required by Federal law]; or subsidized child care).
  

According to CDC, children who receive government assistance and who live in areas where targeted screening is recommended do not require screening if they are at low risk based on the screening questionnaire (CDC 1997, section 5.2.3, p. 62) and if <12% of the children in that community have BLLs ≥10 µg/dL.

In addition to screening of children on the basis of risk questionnaires, screening for lead exposure should be considered in the differential diagnosis of children with unexplained illness such as severe anemia, seizures, lethargy, and abdominal pain.

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